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[Factor analysis of the failed treatment for limb fracture nonunion after autologous bone transplantation]
Kai Li1, Zhao-Ming Ye, Zhong-Wei Zhang
1Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China.
Objective:
To investigate the cause of failure after autogenous bone graft with limb fracture nonunion,to explore the major influencing factor of the treatment, and to research the evidence for improving the treatment of nonunion.
Methods:
A retrospective analysis was done with 367 cases suffering from autogenous bone graft surgery after limb fracture nonunion between January 1995 to December 2011. Among them,there were 198 males and 169 females aged 12 to 89 years (means 53.5 years) with duration of 23 to 49 months. The treatment effect assessed with X-ray and CT after grafting in the treatment, and 32 cases were detected nonunion again, and others' fixations were dismantled by operation after fracture healing. The following correlation including factorsages,gender,smoking, nutritional status during therapy,classification of primary fracture,location of fracture, type of nonunion, changing the type of fixation,type of fixation and complicating disease were evaluated by Logistic stepwise regression to discover the influencing factors of the failure of union.
Results:
The treatment failure rate was 8.72% in the patients with surgery and graft included in the statistics for the late re-admitted in 6 to 12 months followed-up. Smoking, classification of primary fracture, type of nonunion, changing the type of fixation, complicating disease had influence to incidence rate of union after autogenous bone graft.
Conclusion:
Autogenous bone graft is the utility method for limb fracture nonunion. Smoking, classification of primary fracture, classification of nonunion,changing the type of fixation, complicating disease are the risk factors of nonunion after graft. Patients should be advised to stop smoking in the nonunion bone graft. And at the same time, the treatment of related diseases, analysis of the original fracture and nonunion,aggressive treatment of infection, and developing better surgical solutions before surgery, as well as changing the fixation methods can reduce the risk of failure of the graft.
